Provider Demographics
NPI:1386714368
Name:FALCON, EVELYN M (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:M
Last Name:FALCON
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14602 ROSEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2658
Mailing Address - Country:US
Mailing Address - Phone:305-498-1306
Mailing Address - Fax:305-726-0093
Practice Address - Street 1:6625 MIAMI LAKES DR E
Practice Address - Street 2:SUITE 383
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2708
Practice Address - Country:US
Practice Address - Phone:305-498-1306
Practice Address - Fax:305-726-0093
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP0005134235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000925647AOtherPEACHSTATE
GA326070OtherWELLCARE
FL002243700Medicaid
GA10034878OtherAMERIGROUP
GA000925647AMedicaid